Thyroiditis Disease

DESCRIPTION

A variety of inflammatory thyroid disorders that can cause thyroid enlargement and thyroid atrophy. May lead to hypothyroidism or hyperthyroidism. Complete resolution can occur.

Hashimoto's disease - the most common form, an autoimmune disease, often presenting as an asymptomatic diffuse goiter. Often first detected after thyroid atrophy and hypothyroidism have occurred and occasionally as hyperthyroidism ("Hashitoxicosis").
Granulomatous thyroiditis ("subacute") - probably related to viral infection and usually presenting with thyroid pain (which may be severe), involving one or both thyroid lobes, accompanied by hyperthyroidism, going through a phase of mild hypothyroidism and then to permanent resolution to normal.
"Silent" thyroiditis - one form is characterized by spontaneously resolving hypothyroidism and/or hyperthyroidism often associated with pregnancy. Another form has the characteristics of granulomatous thyroiditis without the pain.
Rare forms of thyroiditis - suppurative, due to bacterial infection and radiation due to ingested radionuclides or external irradiation
One form is postpartum onset of goiter and/or hypothyroidism that may resolve spontaneously. Another is painless granulomatous thyroiditis.
Riedel's thyroiditis - dense infiltration of thyroid and surrounding tissues of unknown cause
System(s) affected: Endocrine/Metabolic
Genetics: N/A
Incidence/Prevalence in USA:
- Not known definitively
- Lymphocytic thyroiditis increases with age, probably up to 10% over age 65
- Granulomatous thyroiditis much less common, has an epidemic pattern
Predominant age: All ages, postpuberty
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Lymphocytic thyroiditis
- Insidious onset of goiter, often detected incidentally
- Slow onset of hypothyroidism
- Association with other autoimmune diseases
Granulomatous thyroiditis
- Pain, tenderness, and enlargement of one or both thyroid lobes
- Malaise, fever
- Mild to moderate symptoms of hyperthyroidism
- History of recent respiratory infection

CAUSES

Lymphocytic thyroiditis
- Autoimmune response of thyroid tissue
- Genetic susceptibility
Granulomatous thyroiditis
- Chronic inflammatory response of thyroid tissue
- Preceding infection with any of a variety of viruses

RISK FACTORS

Lymphocytic thyroiditis
- Positive family history of thyroid disease
- Preceding autoimmune diseases including type I diabetes, primary adrenal insufficiency, rheumatoid arthritis, pregnancy/delivery
Granulomatous thyroiditis
- Recent viral respiratory infection
- Other known cases in the community

LABORATORY

Lymphocytic thyroiditis
- Elevated anti-thyroid antibodies (especially high titers of anti-TPO antibodies)
- Free thyroxine index (FTI, normal 4.5–12) less than 5 with TSH greater than 5 mcg/dl (normal 0.5–5 mcg/dl)
- Thyroid radioactive iodine uptake (RAIU) variable with scintiscan showing patchy distribution of radioiodine
- Positive cytopathology of fine needle aspirate or positive formal biopsy
Granulomatous thyroiditis
- Elevated erythrocyte sedimentation rate
- Normal or moderately elevated WBC without a granulocyte shift to band forms
- FTI greater than 12, TSH undetectable, RAIU less than 5% in 24 hours (often nil) early in course
- FTI less than 4.5 with RAIU above normal (greater than 35% in 24 hours in USA) late in course

Drugs that may alter lab results:

Thyroid
Corticosteroids
Iodine-containing drugs and contrast media
Lithium

Disorders that may alter lab results:

Iodine-deficiency
Non-thyroidal illness

PATHOLOGICAL FINDINGS

Lymphocytic thyroiditis
- Lymphocytic infiltration
- Oxyphilic changes in follicular cells
- Fibrosis
- Atrophy
Granulomatous thyroiditis
- Giant cells
- Mononuclear cell infiltrate

SPECIAL TESTS

Immunometric assays
Anti-thyroid antibody titers
Complete blood count with differential count
Erythrocyte sedimentation rate

IMAGING

Thyroid radioiodine uptake and scan in granulomatous thyroiditis
Ultrasonography if hemorrhage into thyroid cyst suspected

DIAGNOSTIC PROCEDURES

Needle biopsy in confusing cases

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Analgesics for pain
Corticosteroids for severe granulomatous thyroiditis

SURGICAL MEASURES

N/A

ACTIVITY

Fully active

DIET

No special diet

PATIENT EDUCATION

N/A

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Treatment induced hypothyroidism or hyperthyroidism

EXPECTED COURSE AND PROGNOSIS

Lymphocytic thyroiditis - persistent goiter, eventual thyroid failure
Granulomatous thyroiditis - eventual return to normal over weeks or months

ASSOCIATED CONDITIONS

Other autoimmune diseases with lymphocytic thyroiditis including type I diabetes, primary adrenal insufficiency, premature ovarian failure

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Remission of granulomatous thyroiditis may be slower in the elderly
Others: N/A

PREGNANCY

Avoid radioisotope scanning
Avoid hypothyroidism
Minimize use of antithyroid drugs

OTHER NOTES

N/A

ABBREVIATIONS

RAIU = radioactive iodine uptake
FTI = free thyroxine index
TSH = thyroid stimulating hormone

Clinical Investigations

ROLE OF HOMOEOPATHY

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